The Current Crisis in Emergency Care and the Impact on Disaster Preparedness

<p>Abstract</p> <p>Background</p> <p>The Homeland Security Act (HSA) of 2002 provided for the designation of a critical infrastructure protection program. This ultimately led to the designation of emergency services as a targeted critical infrastructure. In the context of an evolving crisis in hospital-based emergency care, the extent to which federal funding has addressed disaster preparedness will be examined.</p> <p>Discussion</p> <p>After 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies.</p> <p>Summary</p> <p>Currently, the nation is unable to meet presidential preparedness mandates for emergency and disaster care. Federal funding strategies must therefore be re-prioritized and targeted in a way that reasonably and consistently follows need.</p

Review and Evaluation of the J100â 10 Risk and Resilience Management Standard for Water and Wastewater Systems

Risk analysis standards are often employed to protect critical infrastructures, which are vital to a nation’s security, economy, and safety of its citizens. We present an analysis framework for evaluating such standards and apply it to the J100â 10 risk analysis standard for water and wastewater systems. In doing so, we identify gaps between practices recommended in the standard and the state of the art. While individual processes found within infrastructure risk analysis standards have been evaluated in the past, we present a foundational review and focus specifically on water systems. By highlighting both the conceptual shortcomings and practical limitations, we aim to prioritize the shortcomings needed to be addressed. Key findings from this study include (1) risk definitions fail to address notions of uncertainty, (2) the sole use of â worst reasonable caseâ assumptions can lead to mischaracterizations of risk, (3) analysis of risk and resilience at the threatâ asset resolution ignores dependencies within the system, and (4) stakeholder values need to be assessed when balancing the tradeoffs between risk reduction and resilience enhancement.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154262/1/risa13421_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154262/2/risa13421.pd

Multiplying Diversity: Family Unification and the Regional Origins of Late-Age US Immigrants

Building on claims that the family unification provisions of 1965 Amendments drive changes in both the age composition and the regional origins of US legal permanent residents, we use administrative data to examine empirically whether and how chain migration links these two trends. Specifically, we ask: (1) How does the prevalence of family chain migration differ among major sending regions, and (2) how does the surge in late-age immigration since 1980 vary by source regions and major sending countries? Specifically, we derive age-specific migration multipliers for the major sending regions and the four top source countries. These nations also feature the largest backlogs for numerically capped family visas (Wasem 2012), which has implications for the age composition of sponsored relatives who age as they wait for visas in multi-year queues. In addition to improving on prior estimates of chain migration, our analyses clarify why the age composition of the foreign stock population from Asia and Latin America diverged (He 2002; Grieco et al. 2012). Before describing the data and estimation methods we provide a brief overview of the logic that led to Congress’s gross miscalculation of the impact of the 1965 Amendments on the regional origins of US immigrants. The concluding section discusses the implications of family chain migration in the context of an aging society and contemplated comprehensive reform